Provider Demographics
NPI:1336737576
Name:HAMPTON, MEGAN MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 W GOLDEN CIR
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-1885
Mailing Address - Country:US
Mailing Address - Phone:636-628-7203
Mailing Address - Fax:
Practice Address - Street 1:16921 MANCHESTER RD SUITE B
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040
Practice Address - Country:US
Practice Address - Phone:636-628-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019034594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist